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Wednesday, May 20, 2015

Cancer: Medical Oncology

There are good surprises and bad surprises.  A month after my lumpectomy, I sat down with my oncologist expecting to get a prescription for tamoxifen .  Instead, I got a bad surprise.  

I have never been an overachiever.  All through school, my report card had the comments, “Does not live up to her potential.”  (In my defense, I think they were looking at the wrong potential.  I’m just sayin’.)  Ace my SATs?  No.  Four point GPA?  No.  Have a glamorous and high-paying career?  Nooooo.  Get a high grade on my tumor?  Yeah, here’s where I exceeded expectations.

The early biopsy indicated a Stage 1, Grade 2 cancer, but when the entire tumor was removed, the pathology was a Grade 3.  [Science lesson for today:  Stages 0 to 4 refer to how far the cancer has spread.  I was at Stage 1.  Grade describes how much the cells within the tumor have changed.  Grade One means the cells look pretty normal and grow slowly.  Grade Two cells are somewhat deformed and grow faster.  Grade Three cells are both abnormal and aggressive.]  

A Grade Two with my other signifiers -- clear margins, no lymph node involvement, accompanying biopsy data -- indicated I did not need chemo, but a Grade Three meant reevaluation.  Instead of hustling an IV in my vein to pump me full of life-saving poison, my oncologist sent my tumor to a special lab in California. 

Wait.  They saved the tumor?!  I envisioned a Raiders of the Lost Ark warehouse filled with shelf upon shelf of squishy blobs floating in formaldehyde, perhaps intermittently wriggling with an alien life force.  I was almost sad when nurse-friend informed me that all excised tissue is saved by being frozen.  

They pulled my tumor and sent it off for an oncotype test.  This is a relatively new method of analysis that examines 21 genes in the tissue (Pretty skippy!) and predicts the probability of the cancer’s recurrence anywhere in the body ten years into the future.  A low score means you go straight to radiation therapy.  An intermediate score means more indecision as you and your doctor figure out what treatment to follow (and you’d probably want a second opinion which means more difficult waiting).  A high score and you have to face chemo.

The test takes 10 business days, and the doctor cleared personal time to see me 14 real days later.  I worried the results would not be in by then, but his next available appointment was a whole month off.  I am incredibly lucky that he cared enough to set aside time for me.   
I had already scheduled my radiation simulation for the afternoon of my oncology appointment.  There wasn't time to cancel, but in the four hours between appointments, the oncologist had already called the radiologist!  We went ahead with a consultation, but if I needed chemo, radiation had to follow it, and any preparation done now would have to be re-done.  There was no point taking extra rads with a possibly useless preparatory CAT scan.  We put the simulation on hold.  I waited. 

I felt like I’d been thrown in monopoly jail:  no passing Go, no collecting $200, no moving forward:  just sitting idly in my holding pen trying to mentally parse out possible futures.  Fourteen more days waiting.  Waiting is all fear and anxiety.  It sucks.

I’ll take pity on you:  I won’t make you wait until my next blog post for the results.  At 3:30 on a Saturday afternoon,  just as I was counseling myself that I’d waited 12 days and could make it two more, the oncologist called.  “I have an early Mother’s Day present for you.”  My oncotype was low.  Low!  Low was happy and safe and unambiguous.  No worrying, no waffling, and best of all, no chemo. 

We were finally able to discuss medications.  If you’re, ahem, younger, you get Tamoxifen (an estrogen blocker).  I am not younger.  I am on an aromatase inhibitor.  (It’s not called an estrogen inhibitor. I don’t know why.)  I got my prescription and with it my Get Out of Jail Free card.  

The Monday after Mother’s Day, I called for my radiation simulation appointment.  No one was ever happier about it than I!  

Sunday, May 10, 2015

Cancer: Surgery

So I had a week before surgery, just enough time for a quick trip to see the Perfect Grandchildren (still so very Perfect) before Steve drove me to the hospital for my big morning.  They make you get there forever early, but before I entirely gave up hope,  I was called to pre-op.  The nurse there asked if I knew what procedure I was having done. 

“A lumpectomy with removal of the sentinel lymph nodes.” 

The next nurse asked.  The anesthesiologist’s assistant asked.  The anesthesiologist asked. 

My surgeon asked.  Then she told me I was going to do great.  Really?  All I was gonna do was lie there unconscious.  Yeah, I guess I can do that pretty well.

The person who was in charge of wheeling me to the operating theater asked.

 “Don't you people know yet what you’re doing to me?” 

Unfortunately this person didn't realize I was kidding (yeah, sometimes I should watch my sense of humor).  She explained -- rather at length -- why they asked everyone.  She told me I’d have to answer again when I got to the operating room.

Maybe they asked when I got there, maybe not.  I can’t say.  The anesthesiologist or perhaps her assistant -- I wasn't taking notes -- gave me something so I wouldn't get anxious.  People were praying for me.  Candles were being lighted.  There was a shamanic healing group going, and I’m pretty sure a drum circle had convened.  There’s a kid who’s doing a breast cancer run and is including my name.  Go, kid, go!  I figured all my bases were covered, plus I had complete confidence in my surgeon.  Was I supposed to be anxious?  

She fed my IV anyway and wheeled me out of my cubical.  It was just like being on an episode of “House”!  I lifted my head from the gurney to see pre-op rooms slide by.  Big double doors opened before us, and we turned down a hall, and then, and then I definitely wasn't anxious; I wasn't conscious.  

My nurse friend says, no I was conscious, and I would have answered what my procedure was.  I would have gotten myself off the gurney and up onto the operation table.  Okay.  If she says so, but I have no recollection of any of it.  It makes me wonder, though, what do they do if you can't answer your question?  Are you sent to a remedial pre-op study group for slow patients?  Do you have to have your operation after regular school hours?

I guess I answered okay, because I woke up in my same cubical.  The surgeon reviewed procedure (lumpectomy and removal of the sentinel lymph nodes already!) and told me how well I’d done.  Well, she did well.  Thanks to a nurse dosing my IV, the surgical wounds troubled me very little. 

Before I was sent home, the nurse gave me a little rectangular pink pillow.  “Some people like to hold it under their arm,” she said.  I thought it was the stupidest thing I’d ever seen.  Why would I want to hold a little pink pillow under my arm? 

Let me tell you, I LOVE my little pink pillow.  Even after a month, the scars occasionally smart rather like a mild rug burn, and that little pink pillow can be placed to change the pressure points.  I love it almost as much as I loved the stuffed elephant my father brought me when I was seven after I had my tonsils removed.  I used to burrow my nose into it to block out the smell of the ether.   (Yeah, ether.  I know, right?)  I slept with that elephant for years, and I foresee a long, comforting future with my little pink pillow. 

The two main things to know about post- surgery are that (1) people brought food.  They brought a lot of food.  They brought really good food.  Hey, the damn operation was almost worth it.  (2) I am not a person who is good at being tired, but I found myself lying on the couch every afternoon, too weary to think.  Thank goodness for junk TV which was all I was able to attend to. 

Ten days later, I went for my follow-up appointment.  My surgeon told me how well I’d done.  (Again, didn't do nothin’.)  She cautioned me I’d be tired for from four to six WEEKS!!!  She reminded me to see the medical oncologist.  I’d forgotten entirely about the oncologist, the fellow who would prescribe either an estrogen blocker (like tamoxifen) or an estrogen inhibitor to ward off future breast cancer.  He was a busy fellow, but I scored an appointment two and a half weeks off.  Oncologist for meds in the morning, radiologist to set up my radiation simulation in the afternoon.  Check everything off my list in one day.


Except when I saw the oncologist, I learned that the tumor held a nasty secret.